Contributions
Abstract: PB2192
Type: Publication Only
Background
The new generation drugs and consolidation of response with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (aHSCT) have revolutionized the prognosis of multiple myeloma (MM) patients (pts). However, MM remains a not curable disease and ultimately all pts will relapse, with different studies indicating 16-20% of relapse in the first year after aHSCT.
Nevertheless, the relevance of early relapse after aHSCT in prognosis remains unclarified in the era of more and more effective and diversified treatments.
Aims
We aimed to evaluate the characteristics of pts that early relapse after aHSCT as well as its impact in overall survival (OS).
Methods
We analyzed 207 consecutive aHSCT performed in MM pts in our centre between January/2007 and December/2016. Pts were divided into two groups: R1 (relapse ≤12 months from aHSCT) and R2 (either relapsed >12 months after aHSCT or are disease free at the last follow up). The assessment of response was based on the International MM Working Group consensus criteria (2016).
Results
The median age of the cohort was 59 (27-70) years, 59.4% were male, which was similar between the two groups (p=NS). Thirty-two pts (15.5%) relapsed in the first year post-aHSCT (R1), while 175 (84.5%) relapsed after 1 year or maintain response at the time of the last follow-up (R2). Considering the pts with follow up over 3 years in group R2 (n=127), 30 (23.6%) relapsed between 12-36 months post-aHSCT, 27 (21.3%) relapsed after 3 years and 70 (55.1%) did not relapse after a median follow up of 54.6 months.
Clinical and laboratorial characteristics such as International Staging System score, bone involvement, extramedullary disease and cytogenetic alterations were similar between the two groups. The percentage of pts treated with IMIDs was higher in R1 group (34.4 vs 16.6%; p=0.02), while the number of pts treated with proteasome inhibitor, the number of previous therapeutic lines, and the time between diagnosis and aHSCT were similar (p=NS).
The percentage of patients with complete response (CR) criteria before aHSCT was similar between R1 e R2 (p=NS). However, there was a significant difference when we considered the achievement of CR 100 days after aHSCT, that was higher in group R2 (9.7 vs 13.8%; p<0.001).
The early relapse group presented lower OS after diagnosis (36.3 months vs not reached [NR]; Hazard ratio [HR]=0.18; p<0.001) as well as after aHSCT (15.4 months vs NR; HR=0.14; p<0.001). Considering the group of pts that relapsed during the follow-up (n=89), the OS after relapse was significantly higher in those who relapse after the first year (11.3 vs 79.9 months; HR=0.43; p=0.015).
Conclusion
This study corroborates the concept that early relapse after aHSCT is a major negative prognostic factor, in the era of novel agents, with the sustainability of response being a very important variable. No clinical or analytical variables analyzed seemed to influence relapse timing.
Relapse at the first year correlated inversely with the depth of response at day 100 after aHSCT, in a more relevant way compared with the previous response. These results, conjoining with the absence of correlation between the time diagnosis-aHSCT and the time of relapse, suggest that aHSCT should not be delayed in order to obtain a prior deeper response.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Bone marrow transplant, Multiple Myeloma, prognosis, Relapse
Abstract: PB2192
Type: Publication Only
Background
The new generation drugs and consolidation of response with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (aHSCT) have revolutionized the prognosis of multiple myeloma (MM) patients (pts). However, MM remains a not curable disease and ultimately all pts will relapse, with different studies indicating 16-20% of relapse in the first year after aHSCT.
Nevertheless, the relevance of early relapse after aHSCT in prognosis remains unclarified in the era of more and more effective and diversified treatments.
Aims
We aimed to evaluate the characteristics of pts that early relapse after aHSCT as well as its impact in overall survival (OS).
Methods
We analyzed 207 consecutive aHSCT performed in MM pts in our centre between January/2007 and December/2016. Pts were divided into two groups: R1 (relapse ≤12 months from aHSCT) and R2 (either relapsed >12 months after aHSCT or are disease free at the last follow up). The assessment of response was based on the International MM Working Group consensus criteria (2016).
Results
The median age of the cohort was 59 (27-70) years, 59.4% were male, which was similar between the two groups (p=NS). Thirty-two pts (15.5%) relapsed in the first year post-aHSCT (R1), while 175 (84.5%) relapsed after 1 year or maintain response at the time of the last follow-up (R2). Considering the pts with follow up over 3 years in group R2 (n=127), 30 (23.6%) relapsed between 12-36 months post-aHSCT, 27 (21.3%) relapsed after 3 years and 70 (55.1%) did not relapse after a median follow up of 54.6 months.
Clinical and laboratorial characteristics such as International Staging System score, bone involvement, extramedullary disease and cytogenetic alterations were similar between the two groups. The percentage of pts treated with IMIDs was higher in R1 group (34.4 vs 16.6%; p=0.02), while the number of pts treated with proteasome inhibitor, the number of previous therapeutic lines, and the time between diagnosis and aHSCT were similar (p=NS).
The percentage of patients with complete response (CR) criteria before aHSCT was similar between R1 e R2 (p=NS). However, there was a significant difference when we considered the achievement of CR 100 days after aHSCT, that was higher in group R2 (9.7 vs 13.8%; p<0.001).
The early relapse group presented lower OS after diagnosis (36.3 months vs not reached [NR]; Hazard ratio [HR]=0.18; p<0.001) as well as after aHSCT (15.4 months vs NR; HR=0.14; p<0.001). Considering the group of pts that relapsed during the follow-up (n=89), the OS after relapse was significantly higher in those who relapse after the first year (11.3 vs 79.9 months; HR=0.43; p=0.015).
Conclusion
This study corroborates the concept that early relapse after aHSCT is a major negative prognostic factor, in the era of novel agents, with the sustainability of response being a very important variable. No clinical or analytical variables analyzed seemed to influence relapse timing.
Relapse at the first year correlated inversely with the depth of response at day 100 after aHSCT, in a more relevant way compared with the previous response. These results, conjoining with the absence of correlation between the time diagnosis-aHSCT and the time of relapse, suggest that aHSCT should not be delayed in order to obtain a prior deeper response.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Bone marrow transplant, Multiple Myeloma, prognosis, Relapse